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Pro-Con Debate - Are we making RA too complicated? Con Side
The discussion centers on whether regional anaesthesia is becoming overly complicated, with arguments stressing the importance of accessibility, safety, and evidence-based practices in teaching techniques. Amit Pawa highlights the introduction of new blocks that can simplify training and improve patient care, while advocating for a focus on simpler, reliable techniques. Overall, the document supports the view that, despite advancements, regional anaesthesia should remain approachable for reliable patient outcomes.
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Pro-Con Debate - Are we making RA too complicated? Con Side
- 1. Are We MakingRegional Anaesthesia Too Complicated? PRO CON @amit_pawa#RAUK19 The argument AGAINST the motion
- 2. Disclosures Honororia from GEHealthcare Consult for B Braun Medical Ltd I have helped describe a “new” block @amit_pawa
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- 4. This Time It’sDifferent
- 5. Are We MakingRegional Anaesthesia Too Complicated? The Motion @amit_pawa NO!
- 6. Lloyd had some greatGAGS!!
- 7. THE VERY BESTBLOCK-NAMING BOOK EVER BLOCK AMIT PAWA P. A. W. A Block Posterior Abdominal Wall Analgesia Featuring…
- 8. THE VERY BESTBLOCK-NAMING BOOK EVER BLOCK AMIT PAWA P. A. W. A Block Posterior Abdominal Wall Analgesia Featuring…
- 9. I agree withLloyd to a certain degree… Stop - let’s be serious
- 10. We have aresponsibility Make RA Accessible Anatomical Nomenclature Ensure RA is Evidence-based Make RA Simple Make RA Safe Ensure RA is Taught well Ensure Pts receive RA @amit_pawa
- 11. I think weare doing many, but not all of those things… @amit_pawa
- 12. In the olddays… @amit_pawa Everyone had a go at RA! It wasn’t complicated…
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- 14. Draw a linefrom Turbitt’s tubercle to Pawa’s protuberance. Divide it into 3. Draw a parallel line. Transect the middle of the second line with half way between the lateral thirds…. Blah blah blah @amit_pawa
- 15. Are you tellingme that wasn’t COMPLICATED?!
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- 17. @amit_pawa Use of USRA Time Smart guys “OMG this isso cool” Complications "Now I get it” A graph I made up inspired by @MKwesieKwofie May 2019
- 18. When I didmy fellowship… @amit_pawa
- 19. We Kept thingsrelatively simple Supraclavicular Interscalene Forearm blocks Femoral Popliteal Sciatic @amit_pawa Things have moved on…
- 20. Spinal ultrasound Paravertebral Fascia Iliaca TAP PECS QLB ESP MTP Infraclavicular RAPTIR Adductorcanal Ipack RISS PENG Now we can do… @amit_pawa
- 21. Spinal ultrasound Paravertebral Fascia Iliaca TAP PECS QLB ESP MTP Infraclavicular RAPTIR Adductorcanal Ipack RISS PENG Now we can do… But that is NOT complicated I’ll show you why… @amit_pawa
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- 23. Is it theDoctor? How many blocks they can do? @amit_pawa
- 24. Is it theDoctor? NO! How many blocks they can do? Or what car they drive? @amit_pawa
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- 27. Imaginary Patient… @amit_pawa “Hi DrPawa - I have a patient with multiple rib fractures and impending respiratory failure”
- 28. Imaginary Patient… @amit_pawa “Okay, Canyou Site a thoracic epidural?”
- 29. Imaginary Patient… @amit_pawa “No…they areon Warfarin”
- 30. Imaginary Patient… @amit_pawa “Err, ok- can you site an ultrasound-guided paravertebral?”
- 31. Imaginary Patient… @amit_pawa “No-I havenever done one and I’m too nervous to try”
- 32. Imaginary Patient… @amit_pawa “Err, ok- can you site an ultrasound-guided serratus plane or an ESP?”
- 33. Imaginary Patient… @amit_pawa “YES Ican actually I learned those at #RAUK19 and there are some great on-line videos”
- 34. Increased Choice @amit_pawa Means patientsare more likely to benefit
- 35. High Risk vsLow Risk @amit_pawa Need techniques with less risk…Need techniques with less risk…
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- 39. Ah - Butwe need Evidence you say… @amit_pawa
- 40. 0 50 100 150 200 250 300 350 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Publications per year QLBTEA TPVB Serratus Plane Pecs ESP TEA TPVB QLB SAPB PECS ESP Publications per year @amit_pawa
- 41. Lloyd would say… @amit_pawa “Focuson the simple blocks and don’t make it complicated”
- 42. We Surveyed traineesafter completing their RA training… @amit_pawa Block < 10 performed (%) >10 performed (%) Supraclavicular 77 23 Infraclavicular 97 3 Axillary 54 46 Adductor canal 67 33 Femoral 19 81 Paravertebral 92 8 Serratus 97 3 TAP 27 73 BECOMING FUTURE READY - DEVISING TRAINING OUTCOMES IN REGIONAL ANAESTHESIA FOR POSTGRADUATE TRAINEES BASED ON A SURVEY OF CURRENT PRACTICES. Dr. A Bapat, Dr. J. Lipton, Dr. A Pawa - RAUK 2019
- 43. We Surveyed traineesafter completing their RA training… @amit_pawa Block < 10 performed (%) >10 performed (%) Supraclavicular 77 23 Infraclavicular 97 3 Axillary 54 46 Adductor canal 67 33 Femoral 19 81 Paravertebral 92 8 Serratus 97 3 TAP 27 73 We are not teaching enough “uncomplicated” blocks BECOMING FUTURE READY - DEVISING TRAINING OUTCOMES IN REGIONAL ANAESTHESIA FOR POSTGRADUATE TRAINEES BASED ON A SURVEY OF CURRENT PRACTICES. Dr. A Bapat, Dr. J. Lipton, Dr. A Pawa - RAUK 2019
- 44. We Surveyed traineesafter completing their RA training… @amit_pawa Block < 10 performed (%) >10 performed (%) Supraclavicular 77 23 Infraclavicular 97 3 Axillary 54 46 Adductor canal 67 33 Femoral 19 81 Paravertebral 92 8 Serratus 97 3 TAP 27 73 We are not teaching enough “uncomplicated” blocks Except for TAP BLOCK… BECOMING FUTURE READY - DEVISING TRAINING OUTCOMES IN REGIONAL ANAESTHESIA FOR POSTGRADUATE TRAINEES BASED ON A SURVEY OF CURRENT PRACTICES. Dr. A Bapat, Dr. J. Lipton, Dr. A Pawa - RAUK 2019
- 46. Lets draw thisto a close… @amit_pawa 1. Some of the “new” blocks are confusing (names) 2. We need to teach some blocks well to everyone 3. Some of the “new” blocks make RA safer 4. Some of the “new” blocks are more likely to be performed by non-expert anaesthetists 5. The “new” blocks are increasing RA provision by other specialties…
- 47. Improve access In EmergencyDepartments around the world… PECS blocks - Axillary Abscess drainage RAPTIR blocks - upper limb suturing/fracture manipulation SERRATUS ANTERIOR PLANE blocks - Rib fractures @amit_pawa
- 48. Improve access In EmergencyDepartments around the world… PECS blocks - Axillary Abscess drainage RAPTIR blocks - upper limb suturing/fracture manipulation SERRATUS ANTERIOR PLANE blocks - Rib fractures @amit_pawa
- 49. We have aresponsibility Make RA Accessible Anatomical Nomenclature Ensure RA is Evidence-based Make RA Simple Make RA Safe Ensure RA is Taught well Ensure Pts receive RA
- 50. We have aresponsibility Make RA Accessible Anatomical Nomenclature Ensure RA is Evidence-based Make RA Simple Make RA Safe Ensure RA is Taught well Ensure Pts receive RA This is facilitated by some of the new blocks…
- 51. We have aresponsibility Make RA Accessible Anatomical Nomenclature Ensure RA is Evidence-based Make RA Simple Make RA Safe Ensure RA is Taught well Ensure Pts receive RA This is facilitated by some of the new blocks… SO…
- 52. Are We MakingRegional Anaesthesia Too Complicated? The Motion @amit_pawa NO!
- 53.